Mechanized tracheotome

ABSTRACT

A tracheotome for the mechanized performance of a tracheostomy. The inventive tracheotome, upon triggering, makes an incision through the skin, fascia and trachea of the patient. Then, after the incision has been made, a delayed-action plunger is activated and serves to bend a staple which maintains the opening in the trachea.

United States Patent Amato 1 Feb. 22, 197 2 [54] MECHANIZED TRACHEOTOME [56] References Cited [72] Inventor: Joseph John Amato, North Riverside, Ill. UNITED STATES PATENTS [73] Assignee: United States Surgical Corporation, Bal- 300,285 6/ 1884 Russell 1 28/305 timore, Md.

. Primary Examiner-Channing L. Pace [22] 1969 AttorneyFleit, Gipple & Jacobson 21 A i. No.: 878 457 1 PP 57] ABSTRACT A tracheotome for the mechanized performance of a 52 us. Cl. .1281! R, 128/305, 128/330 tracheosmmy The inventive ,racheowme, upon triggering, [51] "3 Cl 17/00! 17/10 makes an incision through the skin, fascia and trachea of the Fleld of Search R, patient. Then after the incision has been made a delayecLaction plunger is activated and serves to bend a staple which maintains the opening in the trachea.

3 Claims, 8 Drawing Figures PATENIEUrzaaz I872 sum 1 0r 3 INVENTOR JOSEPH J. AMATO 2 zw J ATTORNEYS PATENTEDFEB22 I972 3.643 .649

sum 2 or 3 INvENTo JOSEPH J. AMAT 0-2 a, J f7 ATTORNEYQ PATENTEDFEBZZ I972 SHEET 3 BF 3 mvsmon JOSEPH 'J. AMATO ATTORNEYS MECHANIZED TRACI-IEOTOME BACKGROUND OF THE INVENTION The need for a tracheostomy generally occurs without previous warning, and because of the urgency of the situation, the time allowed for the successful establishment of an airway is extremely limited. The conventional hospital procedure, however, requires anywhere from to 30 minutes for the insertion of a standard tracheostomy tube.

While newer and quicker methods for the performance of a tracheostomy have been presented, and while some of these methods are presently in use, the use is not as widespread as perhaps could be expected. This is because of numerous drawbacks. The major disadvantages of the more current tracheostomy methods are twofold. First, the number of occurrences of complications has been high. And second, numerous of these methods require the skills of the operator to be extremely high.

At the present time, there is no known method for performing a tracheostomy which is quick, effective and yet which can be performed by other than the most skilled surgeons. It is toward the provision of such a method, and an apparatus for practicing the method, that the present invention is directed.

SUMMARY OF THE INVENTION The present invention relates to a mechanized tracheotome. The inventive tracheotome is simple in design, is versatile in use, is relatively simple to operate, is effective, and is relatively inexpensive to manufacture.

The present invention further relates to an economical tracheostomy staple adapted to be used with the mechanized tracheotome, which staple effectively serves to maintain the opening in the trachea in a simple and yet effective manner.

More particularly, the mechanized tracheotome of the present invention is adapted to perform the tracheostomy as a two-step process. Preliminary to the activation of the mechanized tracheotome, the tracheostomy staple is fixedly secured to the neck of the patient so that it is positioned directly over the area where the incision is to be made. The tracheotome is then activated. First, a cruciate-shaped blade is thrust forward, through the staple, the skin, fascia and trachea of the patient. Then, a delayed-action plunger is thrust forward. The plunger causes the tracheostomy staple to be bent open in such a manner that the skin, fascia and trachea of the patient are entrapped by, and retained by, the leaves of the staple. Finally, the tracheotome is removed, leaving behind a tracheostomy staple which defines a square opening in the trachea.

The surgical operation employing the inventive mechanized tracheotome and the inventive tracheostomy staple may be performed rapidly and, because of its simplicity, by persons having only minimal knowledge of anatomy. In addition, the tracheotome is economical and uses an extremely inexpensive tracheostomy staple.

Accordingly, it is.one object of the invention to provide a mechanized tracheotome for the performance of a tracheostomy in a minimum of time and with a maximum of effectiveness.

It is another object of the invention to provide a mechanized tracheotome which is simple to use and yet which is as effee- 1 tive as it is simple.

It is still another object of the invention to provide a mechanized tracheotome which is simple in design and economical in cost.

It is a further object of the invention to provide a tracheostomy staple for use with the inventive mechanized tracheotome, which staple serves to efficiently maintain an opening in the trachea after the completion of the tracheotome stroke.

It is yet another object of the invention to provide a tracheostomy staple which is simple in design and economical in cost.

Still a further object of the invention is to provide a method for performing a tracheostomy in a minimum time and yet with a maximum effectiveness.

Yet another object of the invention is the provision of a method for performing a tracheostomy, which method is simple, quick and yet extremely effective.

These and other objects of the invention, as well as many of the attendant advantages thereof, will become more readily apparent when reference is made to the following description taken in conjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is an exploded perspective of the inventive mechanized tracheotome and the inventive tracheostomy staple;

FIG. 2 is a top plan view of the inventive mechanized tracheotome;

FIG. 3 is a longitudinal section of the tracheotome shown in FIG. 2;

FIG. 4 is a front plan view of the tracheotome shown in FIG. 2;

FIG. 5 is a front plan view of the inventive tracheostomy staple before being acted upon by the mechanized tracheotome;

FIG. 6 is a top view of the staple shown inFIG. 5;

FIG. 7 is a view, partially in section, of the mechanized tracheotome as it is positioned with respect to the patient during the forwardmost portion of the tracheotome stroke; and

FIG. 8 is a front view of the tracheostomy staple as it appears after the completion of the tracheotome stroke.

DETAILED DESCRIPTION OF THE DRAWINGS With reference first to FIGS. I through 4, the inventive mechanized tracheotome will be described. The tracheotome is shown generally at 10 and comprises a partially hollowed body 12 having a trigger 14 on a handle 90. A cruciate-shaped blade I6, having cutting surfaces 15, is fixedly mounted within a blade sleeve 18 which slides in the hollowed portion of the body 12. A plunger 20 having four tines 22 is adapted to slide within the blade sleeve 18 so that, in its forwardmost position, the plunger 20 entirely masks the cutting surfaces 15 of the blade 16. The total cross section of the four tines 22 is substantially equal to the internal cross section of the blade sleeve 15 and, in order that the plunger 20 may mask the cruciateshaped blade 16, the tines 22 are positioned so that four slots 24 are defined thereby. In this manner, relative motion is permitted between the blade 16 and the slots 24, defined by the tines 22. A spring 26 biases the plunger 20 toward the front region of the body l2, the spring 26 being maintained in position by a projection. 28 in the hollow of the body 12 and by a bore 30 in the body of the plunger 20.

A resilient strap 32 is mounted in a recess on the body 12 by means of a pair of rivets 34. The rearwardmost region of the strap 32 has a pair of downwardly extending flanges shown generally at 35 defining a camming surface 36 and a stop 38. An upwardly extending flair 40 is also provided on the rearwardmost portion of the strap 32. The plunger 20 is provided with a pair of grooves shown generally at 42, each groove 42 adapted to associate with a respective downwardly extending flange 35 on the strap 32. The grooves 42 each have an inclined surface 44, a flat 46 and a stop-engaging surface 48. The stop-engaging surface 48 on the plunger 20 is adapted to associate with the stop 38 on the resilient strap 32. The incline 44 and the flat 46 in a given groove 42 serve to house a respective downwardly extending flange 35.

At the rear upper portion of the body I2 is provided a slot 50. The slot 50 allows for the communication of a plunger-engaging extension 52 on a drive shaft 54 with a slot 56 in the blade sleeve 18. The drive shaft 54 is activated by means of a power unit shown generally at 58. The forwardmost region of the slot 56 in the blade sleeve 18 is fitted with an upwardly extending flange-60 to ensure positive engagement between the sleeve 18 and the pusher-engaging extension 52 on the drive shaft 54.

The blade sleeve 18 is provided with a pair of elongated slots 62 on the upper rear surface thereof, the slots 62 being fitted to allow the blade sleeve 18 to slide in the hollow of the body 12 without interfering with the downwardly extending flanges 35 on the strap 32. Thus, the blade sleeve 18 is free to move in its hollow while the resilient strap 32 is flat in its housing and in engagement with the plunger 20.

The forwardmost part of the blade sleeve 18 is, in cross section, a square. The rearwardmost part, however, is U-shaped in cross section. This can best be seen in FIGS. 1 and 3. At the transition between the square cross section and the U-shaped cross section of the blade sleeve 18, there is defined a ledge 64. This ledge 64 is adapted to engage a corresponding ledge 66, extending across the bottom surfac'e'of the plunger 20. In this manner, the forward motion of the plunger 20, relative to the blade sleeve 18, is limited to the position taken by the plunger when the respective ledges 64 and 66 are in communication with one another. This forwardmost position is fixed so that the tines 22 of the plunger 20 mask the cutting surfaces of the blade 16.

As best seen in FIG. 3, the blade sleeve 18 slides in the ho]- low of the body 12 on its wall 68. Similarly, the plunger slides in the hollow of the body 12 on a bottom extension 70. The tines 22 of the plunger 20, however, slide within the square cross-sectional region of the blade sleeve 18 and, therefore, slide along the internal surface of the lower wall 68 of the sleeve 18.

The forwardmost region of the body 12 defines a nozzle shown generally at 72. See FIG. 2. The nozzle 72 is in the form of a wide fan-shaped member with an indentation 74 therein, and is provided with a cushion 76 on its forwardmost surface completely encompassing the indentation 74. The nozzle 72 and the indentation 74 are adapted so that the indentation may comfortably be placed and pushed against the lower border of the neck so as to encompass the anterior surface of the trachea.

With reference now to FIGS. 1, S and 6, the configuration of the tracheostomy staple will be described. The staple is shown generally at 78 and comprises a pair of side straps 80, each strap having a hole 82 therein, and further comprising a central region shown generally at 83. As shown best in FIG. 6, the central region 83 is an extension ,of the side straps 80 and has fixed thereon four pyramid-shaped projections 84.

Through the central region of the staple 78 are a pair of slits 86, the slits 86 forming a cross adapted to accommodate the cruciate-shaped blade 16 and to permit the passage of same therethrough. For reasons which will become more readily apparent from the following, it may be necessary to provide the central region 83 of the tracheostomy staple 78 with some arrangement of means for allowing the bases of the pyramidshaped projections 84 to be bent along the lines 88.

The holes 82 in the side straps 80 provide means for securing neck straps to the staple, which neck straps encircle the neck of the patient and hold the staple 78 secure over the area where it is desired to make the incision.

In operation, the mechanized tracheotome of the present invention functions as follows. The tracheostomy staple 78 is first strapped to the neck 92 of the patient, comfortably and yet firmly, at the position over the region where the incision is to be made. Then, the nozzle 72 is placed at the throat of the patient so that the indentation 74 encompasses the anterior surface of the trachea. This is shown in FIG. 7 (the neck strap shown at 94, but hanging loosely for clarity). The operator holds the mechanized tracheotome at the handle 90 of the body 12. When the operator is ready to perform the tracheostomy, the trigger 14 is depressed.

Before the depression of the trigger 14, the relative positions of the blade 16 and the plunger 20 are as shown in FIG. 3. Once the trigger is depressed, the power unit 58 is activated (by means not shown), and the drive shaft 54 is thrust forward. Since the pusher-engaging extension 52 of the drive shaft 54 is in positive engagement with the slot 56 in the blade sleeve 18, the blade sleeve, with its associated blade 16, is thrust forward with the drive shaft 54.

As noted above, the ledge 64 on the blade sleeve 18 is adapted to abut the ledge 66 on the plunger 20. Therefore, as shown in FIG. 3, before the activation of the power unit 58, the blade sleeve 18 is held in its rearwardmost position by the drive shaft 54. The plunger 20 is, in turn, held in its rearwardmost position, against the thrust of the spring 26,: by the abutting ledges 64 and 66 of the blade sleeve and plunger, respectively. In this position, the downwardly extending flanges 35 on the resilient strap 32 rest comfortably within the depressions 42 in the plunger 20. However, a small space, shown at 92, is present between the stop 38 on the strap 32 and the stop-engaging surface 48 on the plunger 20.

When the power unit is activated, as noted above, the blade sleeve 18 is thrust forward. Due to the force exerted by the spring 26, the plunger 20 is also thrust forward, a small distance, until the stop 38 on the resilient strap 32 contacts the stop-engaging surface 48 on the plunger 20. When this occurs, the plunger 20 is held fixed while the blade sleeve 18 moves forward with itsv associated cruciate-shaped blade 16. The blade continues its forward motion while the plunger remains stationary until a cammi'ng surface 94, on the drive shaft 54, engages the upwardly extending flare 40 on the resilient strap When the drive shaft 54 moves forward a small distance after contacting the flare 40, the resilient strap 32 is bent upwardly and, as a consequence, the downwardly extending flanges 35 become disengaged from the grooves 42 in the plunger 20. When the stop 38 on the strap 32 is free from the stop-engaging surface 48 on the plunger 20, the plunger is thrust forward by the action of the spring 26. This occurs near the end of the stroke of the blade 16.

As noted previously, and as is shown in FIG. 7, the tines 22 on the plunger 20 mask the cutting surfaces 15 of the blade 16 when the plunger is forward with respect to the blade sleeve. In this manner, the instrument may be retracted from the neck of the patient without the fear of injury to the patient.

Relating the operation described above to the formation of the tracheostomy staple 78, the following is pertinent. When the blade 16 is thrust forward, the cutting elements 15 comfortably pass through the slits 86 in the staple 78. The blade 16 then cuts through the skin 96, fascia 98 and trachea of the patient.

When the blade 16 nears the forwardmost portion of its stroke, the plunger 20 is released from its stop. Therefore, the plunger is thrust toward the staple 78 and the forwardmost and tapered regions of the tines 22 engage the rear surface of the staple 78. The tines are arranged to abut the staple near the central region thereof and are adapted to bend the staple about the dotted lines 88 and into the position shown in FIGS. 7 and 8.

Thus, the blade first slides between the leaves of the staple and, upon so doing, makes way for the passage of the staple into the area of the incision. Then, the plunger comes forward and the staple leaves are forced laterally into the trachea with each leaf holding the tissue back, resulting in a square opening in the trachea. As seen in FIG. 7, the pyramid-shaped extensions 84 on the staple 78 maintain the skin 96, fascia 98 and trachea 100 in an open position. The shape of extensions 84 aids in the prevention of excessive bleeding of the patient in the area of the incision.

Above, there has been described a specific embodiment of the present invention. The invention relates to a mechanized tracheotome for positioning a tracheostomy staple which replaces the tracheostomy tube presently in use, the function of the tracheostomy staple being to maintain the airway open and, thus, performing an identical function with the conventional tracheostomy tube. It should be appreciated that the specific embodiment of the present invention has been described for illustrative purposes only and that many alterations and modifications of the invention may be practiced by those skilled in the art without departing from the spirit and the scope thereof. Particularly, the configuration of the tracheostomy staple may be changed and the configuration of in alignment with the area where the incision is to be made, a

tracheostomy staple having a central region provided with a pair of crossed slits; inserting an instrument through said slits and making an incision through the skin, fascia and trachea of the patient; and bending portions of said tracheostomy staple into the trachea to ensure that the staple maintains the skin, fascia and trachea of the patient in a position whereby an airway is established.

2. The method as described in claim 1 wherein said crossed slits define triangular subregions; and wherein said triangular subregions, when bent, maintain the skin, fascia and trachea of the patient in a position defining an airway.

3. The method as defined in claim 1 wherein the incision is made by a tracheotome inserted through the slits in said tracheostomy staple and wherein said staple is bent by means of a plunger in the tracheotome. 

1. A method of performing a tracheostomy, the method comprising the steps of: positioning over the neck of a patient in alignment with the area where the incision is to be made, a tracheostomy staple having a central region provided with a pair of crossed slits; inserting an instrument through said slits and making an incision through the skin, fascia and trachea of the patient; and bending portions of said tracheostomy staple into the trachea to ensure that the staple maintains the skin, fascia and trachea of the patient in a position whereby an airway is established.
 2. The method as described in claim 1 wherein said crossed slits define triangular subregions; and wherein said triangular subregions, when bent, maintain the skin, fascia and trachea of the patient in a position defining an airway.
 3. The method as defined in claim 1 wherein the incision is made by a tracheotome inserted through the slits in said tracheostomy staple and wherein said staple is bent by means of a plunger in the tracheotome. 